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Theory Of Radiographic Practice > Chest /respiratory X Rays > Flashcards

Chest /respiratory X Rays Flashcards

1
Q

Skeletal anatomy of chest
(7)

A

Ribs
Spine
Vertebrae
Scapulae
Clavicles
Sternum
Proximal humerus

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2
Q

Cartilaginous structures of chest cavity

A

Xiphoid process or xiphisternum

Costal cartilage

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3
Q

Respiratory anatomy of the chest

A

Lungs
Airway s
Diaphragm

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4
Q

Digestive anatomy of chest

A

Oesophagus

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5
Q

Circulatory

A

Heart
Major blood vessels - arterial or venous

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6
Q

What is the difference between the lobes in the right and left lung

A

Right lung has 3 lobes
Left lung has 2 lobes to make room for the heart as the hearts apex is tilted to the left which makes the left lung smaller than the right

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7
Q

Fissures

A

Lines on the lungs

2 on right and 1 on left

Right horizontal fissure
Right oblique fissure
Left oblique fissure

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8
Q

What do we take chest x rays for

A

Clinical indications
-lung disease
-infections
-tumours

Cardiac assessments
Airway assessments
Bony assessments

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9
Q

Standard projections of CXR

A

PA
AP

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10
Q

Non standard projections for CXR

A

Lateral

Oblique - usually for fractured ribs

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11
Q

How to do a PA chest x-ray

A

X ray tube and beam behind patient
Patients chest touching detector to reduce magnification of chest cavity

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12
Q

Why PA CXR view

A

-gold standard CXR so no annotation required unless an alternative projection like an AP used
-improves image quality and is sharper
-Reduces magnification of the heart
-less dose on the thyroid gland since its radio sensitive

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13
Q

When the object is _____________ to the detector it is ________________ and _______________.

A

When the object is closer to the detector it is smaller and sharper on the image

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14
Q

Positioning for PA CXR

A

-patient stood up straight
-chest close to detector (touching)
-medial saggital plane is perpendicular and at right angles to detector
-shoulders shrugged forwards which moved scapula out of lung field
-dorsum of hands on hips
-elbows partially flexed and forwards
-head and neck straight and forward
-tell patient to breathe in but leave shoulders relaxed which shows apex
-expose patient at deepest breath in but remember to tell them to breathe again

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15
Q

How to assess a CXR

A

10 point checklist (PAC ACC DAAR)
1.patient ID- 3 forms of ID
2. Area of interest- thorax
3. Correct protection - PA no annotation required
4.Anatomical markers- Left marker electronically placed
5.collimation- shoulders to the 12th rib / costal margins
6.correct exposure- lung markings, vertebra visible behind heart shadow
7.definition/sharpness - clear and sharp, costophrenic and cardiophrenic angles visible, diaphragm clearly outlines
8.artefacts- none visible
9.any pathology- nothing obvious
10. Any need for a repeat- NO

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16
Q

Assessing a CXR for a good patient position

A

-medial ends of clavicles needs to be equidistant so same length away from vertebrae

-scapula needs to be out of lung fields

-vertebrae needs to be seen behind the heart shadow

17
Q

If the lung fields looks fuzzy what does the patient have to do…

A

Chest infection

18
Q

Cardiothoracic ratio (PA CXR only)

A

Ratio of the greatest transverse dimension of the heart to the greatest transverse dimension of the chest cavity

0.42-0.5 ratio is normal

Detects enlargement of the heart if above 50% of the chest cavity
Which is known as cardiomegaly

Further cardiac investigations are normally needed for a higher ratio

19
Q

Cardiomegaly

A

An enlarged heart on a PA CXR

Normal = cardiothoracic ratio is less than 0.5/ 50%

Can have pacemakers

20
Q

When do you take an Anterior posterior CXR and what is the positioning ?

A

-When PA is not possible
-patient neeeds to be sat upright or supine and as straight as possible
-medial saggital plates at right angles to the detector
-patients back against the detector
-x ray beam from the front
-scapula as lateral as possible to keep out of lung field (shrug forwards)
-chin up (look up)
-practice a breathe in and holding
-x ray Beam perpendicular to the detector

21
Q

AP CXR image assessment

A

10 point checklist
PAC AAC DAAR

Can do AP in supine position in ITU or the resuscitation room but ensure its annotated as supine so report can be accurate

Erect (upright) in standard anatomical position

22
Q

SID for erect and supine

A

SID- Erect 180cm
SID- supine 100cm

23
Q

Detector side for AP or PA

A

43 x 53cm (large)

24
Q

Centering point for PA and AP

A

PA- T7 vertebra (bottom of scapula aligns with T7)

AP- mid sternum (15-25 degree caudal angle)

BOTH PERPENDICULAR TO DETECTOR

25
Q

Grid / Bucky for PA or AP

A

PA - yes reduces scatter for larger body areas

AP- yes/no dependent on x-ray unit sometimes a stimulated grid algorithm used

26
Q

Automatic exposure chambers for PA or AP

A

PA- AEC selected lateral
AP- NA as we use free detector

27
Q

Collimation for PA and AP

A

PA + AP - shoulders to just above lower costal margins
Lateral chest skin borders

28
Q

Focal spot for PA and AP

A

Focal spot sizes is dependent on body area and thickness

PA- Large focal spot size

AP -large focal spot size

Due to thicker Body parts in chest cavity

29
Q

Exposure factors for PA

A

120 kV - more energy
1.6 mAs - less radiation dose

30
Q

Exposure factors for AP

A

90 kV
1.6 mAs

31
Q

Give an emergency critical situation of chest cavity

A

Pneumothorax

32
Q

Pneumothorax

A
  • collapsed lung (looks shrunken)
    -air leaks into pleural space between lung and chest wall
    -pressure from outside air forces lung to collapse
    -shortness of breath (SOB)

In this case do not send the patient home, they require. Urgent review by doctor/ consultant for treatment or intervention

33
Q

What will pneumothorax look like on image and is most common in whom?

A

No lung markings
Occur sporadically

Common in slim tall males

Following trauma

34
Q

What will pneumothorax look like on image and is most common in whom?

A

No lung markings
Occur sporadically

Common in slim tall males

Following trauma

35
Q

Tension pneumothorax

A

Puncture of pleural space
Air enters pleural cavity with no means of escape from lungs
Lung is then collapsed under pressure
Heart blood vessels and airways displaced
Cardiopulmonary function compromised

Severe condition - early recognition is crucial

36
Q

What to do with your patient with pneumothorax

A

Do not send home
Get them reviewed by a doctor for treatment or intervention asap
Get a wheelchair or trolley to transport them to emergency department

Theory Of Radiographic Practice (5 decks)

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